Cervical Adenitis
It is an infection of the tonsils, submandibular, submental, occipital, superficial and deep jugular, nuchal, spinal accessory and transverse cervical lymph nodes located between the deep and superficial fascias in the neck. The causative agents are generally viruses, S. aureus, group A streptococci, other streptococci, anaerobic bacteria, Bartonella henseleae, atypical mycobacteria and Gram-negative bacilli.
Acute bilateral adenitis is more likely to be caused by viruses and group A streptococcus, acute unilateral adenitis. S. aureus, group A streptococcus, anaerobic bacteria and viruses, while subacute and chronic adenitis is caused by atypical mycobacteria, tuberculosis, toxoplasmosis and cat scratch disease (Bartonella henseleae).
Rarely, M. tuberculosis, fungi, T. gondii, F. tularencis, Y. pestis, HIV and C. diphtheriae may also be the causative agent. Microorganisms usually come to the lymph nodes from the upper respiratory tract, tonsils and teeth or through trauma, rarely through the blood.
Clinical
Depending on the duration of lymph node growth and whether it is unilateral or bilateral. It varies depending on the situation. Systemic symptoms are usually absent or mild. If there is cellulitis or bacteremia in the surrounding tissue, high fever may occur.
Especially in cases of streptococcal adenitis, there may be symptoms of upper respiratory tract infection initially. The lymph node size may be up to 2-6 cm. The submandibular glands (50-60%) and upper cervical glands (25-30%) are most commonly affected.
The skin over the gland is usually hyperemic and there is local temperature increase. Fluctuation occurs in approximately ΒΌ of the cases. Suppuration may occur mostly in S. aureus and mycobacteria infections. Other areas where lymph nodes are concentrated (above the clavicle, axilla and inguinal region) should be checked, and spleen and liver size should be investigated.
If there is widespread lymphadenopathy and hepatosplenomegaly in the body, cervical lymphadenopathy is usually caused by a systemic disease (EBV). It developed in response to viral infections such as CMV, toxoplasmosis, tuberculosis, collagen tissue diseases, leukemia?). Information about the possible primary source is obtained by examining the areas where lymph drainage passes through the neck, such as the oral cavity, pharynx, nose, ear, and scalp.
Complications
Abscess formation, cellulitis, bacteremia, internal jugular vein thrombosis, agent-related complications (acute rheumatic fever, glomerulonephritis, scalded skin syndrome?)
Diagnosis< br /> In mild cases, clinical diagnosis is sufficient. However, if there is no response to antibiotic treatment, a sample should be taken by needle aspiration or incision, stained with Gram, Wright and Ziehl-Nielsen stains, examined, and evaluated cytologically and pathologically if necessary. In severe cases, it would be appropriate to take a sample before starting treatment. In persistent adenitis that has not been diagnosed in 8-12 weeks and if there are findings compatible with neoplasia (lower cervical and supraclavicular lymphadenopathies, weight loss, persistent fever, adhesion to the skin and deep tissues)
Differential Diagnosis
Mumps, bacterial parotitis, dental abscesses, congenital neck masses (thyroglossal duct cyst, branchial cleft cyst, cystic hygroma, epidermoid cyst), neck tumors (lymphoma, neurogenic tumors, thyroid tumors, parotid tumors, Kawasaki disease, drug reactions, collagen tissue diseases, sarcoidosis, reticuloendothelioses, storage diseases.
Treatment
When the lymph node does not grow much, its sensitivity is low and it is the primary focus of infection. In mild cases where there is no antibiotic treatment, it is sufficient to monitor the lymph node with weekly checks until it starts to shrink.
If the growth continues or when the patient presents, the lymph node is large (but less than 3 cm), If the skin is tender, red, and there is no primary focus of infection, oral empiric antibiotic treatment is started and monitored until shrinkage occurs. Flucloxacillin, cephalexin, clindamycin or amoxicillin/clavulanate can be used as antibiotics in these patients.
If the lymph node is 3 cm or larger, is inflamed, has cellulitis and/or has systemic symptoms and findings, and has not responded to initial antibiotic treatment. It would be appropriate to hospitalize the patient and take a sample through incision or drainage. If the causative agent cannot be detected, or while waiting for the results, one of the parenteral clindamycin, cefazolin + metronidazole, sulbactam/ampicillin or vancomycin (or teicoplanin) + metronidazole treatments can be started.
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